Retail Alcohol Monopolies: Alcohol: Not Just Another Consumer Product

Alcohol: Not Just Another Consumer Product
 
Alcohol is not a benign consumer product.  Alcohol-related problems impose a heavy burden on public health and safety. Alcohol abuse costs billions of dollars in additional health care, law enforcement, court cases and lost productivity.  Many people drink at low-risk levels e.g., (Bondy et al., 1999) and many drinkers do not encounter serious problems with alcohol.  Nevertheless, one in ten people in Ontario runs a high risk of alcohol dependence, and about 3% of the adult population are severely dependent on alcohol (Single et al., 1998).

Even moderate levels of alcohol use--such as taking several drinks a day over a number of years-- are not risk-free, and are associated with an increased risk of certain cancers (e.g., Corrao et al., 1999) and other chronic conditions (e.g., Babor et al., 2003; Edwards et al., 1994).  Alcohol-related harm is associated with a variety of drinking behaviours, including alcohol dependence, regular consumption over longer periods of time, or with moderate drinking mixed with occasional heavy-drinking episodes.  In one study, about 50% of alcohol-related costs were associated with drinking by people not classified as dependent or with a diagnosis of alcohol abuse or harmful use (Rehm, 1999). Therefore, even persons who may typically drink moderately, with occasional heavy-drinking episodes, can experience alcohol-related harm, whether to themselves or others (Room et al., 1995a). One Ontario-based community survey showed that during the previous 12 months over 70% of respondents had experienced a problem due to another person's consumption  (Allen et al., 1998). Higher rates of alcohol consumption are associated with a higher incidence of injuries, increased risk of certain diseases, increased fetal alcohol syndrome/effects, increased risk of mental illness, more crime and reduced worker productivity (e.g., Edwards et al., 1994; Rehm et al., forthcoming).

In Canada, alcohol plays a role in thousands of deaths each year through heart and liver disease, cancer, suicide, traffic crashes and other accidents. In Ontario, the estimated annual cost of alcohol-related lost productivity, health care and enforcement services was  $ 2,861,926, 000 in 1992 (Single et. al., 1996).   Also, in Ontario, the number of people reporting at least one alcohol-related problem as a result of their drinking was about 350,000 in 1995- roughly the population of London, Ontario (Kavanagh & Bondy, 1995).  Over half of the people convicted of assault, murder or attempted murder in Ontario had been drinking before they committed the crime (Addiction Research Foundation, 1994).  Alcohol was used by the aggressor in 50% of cases of spousal assault, and in 38% of child abuse cases in Ontario (Addiction Research Foundation, 1994).  These health, social and economic costs highlight the need for socially responsible and effective control measures in the matter of alcohol sales and use.

Extensive research over the past thirty years shows a strong positive relationship between per capita consumption and levels of drinking-related harm in the population (e.g., Bruun et al., 1975; Moore & Gerstein, 1981; Edwards et al., 1994).  More recent research using Canadian and European data provides current new support for these key findings. These studies found strong associations between population level drinking rates and death rates from all causes (Norström, 2001, 2002), and acute events (Ramstedt, 2002b; Rossow, 2001, 2002; Skog, 2003) and chronic conditions associated with alcohol  (e.g., Xie et al., 2000; Ramstedt, 2002a, 2002c, 2003).

Of particular relevance is recent research focusing on several Canadian provinces that examined alcohol consumption rates and damage indicators from the 1950s to the late 1990s. This work demonstrated that there was a positive association between population level drinking rates and mortality from all causes (Norström, 2002), liver cirrhosis (Ramstedt, 2003), alcohol-related mortality (Ramstedt, 2002c), violent deaths (Rossow, 2002), drinking and driving crashes (Skog, 2003) and suicides (Ramstedt, 2002b).  A main conclusion from this research -- which is also in line with earlier work noted above -- is that if there is more drinking in a population, the risks of serious consequences increase. Therefore, public health and safety policies that regulate accessibility to alcohol have beneficial implications for people with a wide range of drinking experiences and practices, and for others in the community who do not drink alcohol or drink very little.

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